title: Suppurative thyroiditis in children: a management algorithm.
abstract: OBJECTIVE
  To elucidate the etiology of suppurative thyroiditis in children and recommend a management algorithm.
  
  
  METHODS
  Case series of 5 pediatric patients with a diagnosis of suppurative thyroiditis seen between January 1999 and April 2007.
  
  
  RESULTS
  All 5 patients primarily presented with left-sided intrathyroidal abscesses. The number of infections from first presentation to the time of definitive diagnosis ranged from 1 to 5. Three patients underwent incision and drainage of the abscess once, and 2 had the procedure performed 3 times. Barium swallows identified a piriform sinus tract on the left side in 2 of the 5 patients. Telescopic hypopharyngoscopy identified the internal opening in all 5. Three were managed with complete excision of their tracts and 2 with cauterization of the internal opening with silver nitrate. All 5 are currently asymptomatic.
  
  
  CONCLUSIONS
  Suppurative thyroiditis is a very rare infection in children. A left-sided intrathyroidal abscess should immediately arouse suspicion of a piriform sinus tract. Barium swallows may identify the etiology in some cases. Definitive diagnosis requires a hypopharyngoscopy, with detailed telescopic examination of the left piriform fossa apex. Endoscopic chemical cautery of the internal opening is a safe and effective technique, with very low morbidity, and has the potential for cure.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, USA.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Smith
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001934:Branchial Region / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D005260:Female; D005402:Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D010608:Pharyngeal Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013961:Thyroid Gland; D013969:Thyroiditis, Suppurative / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents